Rehabilitation for Anterior Cruciate Ligament Injury
The anterior cruciate ligament (ACL), which runs diagonally through the middle of the knee, is one of the knee's most frequently injured ligaments. About half of all ACL injuries are accompanied by damage to the meniscus, cartilage, bone or other ligaments in the knee, complicating the healing process. After initial treatment of rest, ice, compression and elevation (RICE), a patient with an ACL injury will require physical therapy.
For some patients, physical therapy is necessary before and after surgical repair. For others, physical therapy alone is sufficient. If the patient undergoes rehabilitation without surgery, however, the knee may be unstable during certain movements.
Nonsurgical Rehabilitation
Early therapy for an ACL injury involves periodic applications of ice to reduce swelling. A knee brace is often worn for support and compression, and crutches or splints may be used for a few days to keep weight off the affected knee. It is important that physical therapy begins soon after the injury occurs to prevent joint stiffness and muscle atrophy. Rehabilitation to help relieve pain, reduce swelling, prevent muscle spasms and increase mobility includes the following:
- Electrical stimulation
- Ultrasound
- Light massage
- Range-of-motion exercises
- Strengthening exercises
- Isometric exercises
- Balance exercises
- Proprioceptive exercises
The therapeutic routine is adjusted to accommodate the individual patient's condition and tolerance level.
Postsurgical Rehabilitation
In order to give the patient the best chance of regaining full knee function, physical therapy begins right after ACL-repair surgery. It may continue for several months until the patient is able to resume normal activities. As the weeks pass, postsurgical rehabilitation takes place in stages, a process known as "functional progression."
In the first days after surgery, a patient may be instructed in how to use a continuous passive motion (CPM) machine, although there is some controversy as to whether using it actually helps. In the ensuing weeks, rehabilitation includes some or all of the following:
- Exercises to strengthen the quadriceps and hamstrings
- Range-of-motion exercises
- Extension (stretching) and flexion (bending) exercises
- Therapeutic walking
- Ultrasound
Postsurgical rehabilitation usually takes several months, and it may take a month or two beyond that for a patient to be able to fully engage in athletic activities.